Provider Demographics
NPI:1235675190
Name:QUEENS MIDNIGHT PHARMACY INC
Entity Type:Organization
Organization Name:QUEENS MIDNIGHT PHARMACY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:ALEX
Authorized Official - Middle Name:
Authorized Official - Last Name:KOCHANOFF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-533-0991
Mailing Address - Street 1:10426 ROOSEVELT AVE
Mailing Address - Street 2:
Mailing Address - City:CORONA
Mailing Address - State:NY
Mailing Address - Zip Code:11368-2328
Mailing Address - Country:US
Mailing Address - Phone:718-533-0991
Mailing Address - Fax:718-205-8340
Practice Address - Street 1:10426 ROOSEVELT AVE
Practice Address - Street 2:
Practice Address - City:CORONA
Practice Address - State:NY
Practice Address - Zip Code:11368-2328
Practice Address - Country:US
Practice Address - Phone:718-533-0991
Practice Address - Fax:718-205-8340
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-16
Last Update Date:2017-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
NY0235983336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2167932OtherPK